I had an accident at work. How do I file a workers compensation claim in my state?

In the event of an accident during the course of your work, use the Notice of Accident forms to notify your employer about your injury. Your employer should have these forms readily available for you. This form should be completed within fifteen (15) days or sooner. Your employer must also sign and date this form and give you a copy.

If your employer witnesses the accident, they are considered to have received notice.

Should my employer have workers compensation insurance? How do I know if I am covered?

New Mexico state law requires that employers with three or more employees and employers licensed in the construction industries have workers compensation coverage. The employer is expected to purchase a coverage plan from a private insurance provider or to become an approved self-insurer. The Workers' Compensation Administration is the only legal entity able to approve an employer's self-insurance coverage.

What are the conditions that enable me or prevent me from claiming benefits under my state's law?

Workers' compensation provides benefits for injuries caused by accidents occurring during the course of your employment. However, not all injuries or illnesses will be covered. This will depend on the scope, severity, and/or details surrounding how your injury occurred.

Covered

Usually Covered

Usually Not Covered

Not Covered

Injury at work during normal work hours

Injury at work during other hours

Injury while commuting between home and work

Injured caused by injured worker using drugs or alcohol

Injury while traveling for work purposes

Injury at work but not work-related

Injury outside work that affects your ability to do the job

Horseplay while disregarding employer safety rules or instruction

What benefits might I be eligible to receive?

Workers' compensation is a system of benefits that provides for payments of medical care related to work-injury; wage replacement if you are unable to return to work due to your injury for a period of seven days or more; long-term compensation for injuries that require permanent care or cause permanent disability.

Wage replacement benefits will vary case to case. How much money you will receive will depend on the severity of your injury, how long it takes to recover, and how much money you earned in wages prior to the injury.

Temporary Total Disability Benefits are benefits paid to you starting on the eighth day you are absent from work as a result of your injury. The amount you are likely to receive if you qualify for this kind of benefit is roughly two-thirds of your average weekly wage (gross wages you have earned over the previous twenty-six (26) weeks at your place of employment). In order to reclaim the first seven (7) days of wages, you must remain unable to return to work for a period of twenty-eight (28) days.

During the course of treatment of medical care, there will come a point where your doctor may conclude that no more treatment is either necessary or that your injury/illness has reached Maximum Medical Improvement. At this point, the insurance provider is no longer required to pay you temporary total disability benefits.

In certain situations, an injury or illness may cause total body or total body member impairments. In these cases, you may be entitled to Permanent Partial Disability benefits where you are subject to receive payments for the loss of use or function to portions of your body. In other situations, you may receive Permanent Total Disability Benefits if you have lost the use of both hands, both feet, both arms, both legs, both eyes or suffer from a brain injury; suffer a thirty percent (30%) impairment. These payments are paid to you for the rest of your life.

Death benefits may be available to your survivors, such as a spouse or children, in the event that your work-related injury or illness results in your death. This will include wage benefits, again calculated as roughly two-thirds of your average weekly wages, and money to supplement funeral expenses.

How much time do I have to file my claim? What are the stages of the claims process? What should I expect?

After notifying your employer and completing a Notice of Accident form, your employer or your employer's insurance provider will complete a First Report of Injury or Illness. You should receive a copy of the completed form for your own personal records. A claims representative (usually an individual working for or with your employer's insurance provider) will be assigned to your claim and will review the circumstances surrounding your injury/illness, will review your bills and health records, and will determine how much is owed to you in terms of benefits.

If the insurance provider decides that they will not accept liability for your claim, you should contact a state Ombudsman. The New Mexico Workers Compensation Commission provides an Ombudsman Program to assist you with the claims process. Ombudsman are specialized in the workers' compensation arena.

If a dispute should arise between you and your employer, the Workers' Compensation Commission provides a dispute resolution service to help informally resolve your claim. The commission recommends the informal dispute resolution; it is quick and inexpensive in comparison to formal litigation. If both parties agree to the resolution, it becomes a binding court order. However, if one of the parties disagrees, you must send the rejection back to the WCA within thirty (30) days of the decision. A formal trial will then be scheduled.

You may choose to proceed through a more formal dispute, in which case you must file a complaint with the WCA. Either a lawyer or an Ombudsman may assist you through this process; however, if you choose to retain a lawyer, an Ombudsman may not speak to you about your claim.

The formal trial is overseen by a WCA judge.

If I am not happy with the determination, how do I appeal?

Determinations made by the WCA are appealable to the New Mexico state court. The rules, filing requirements, and guidelines will be governed by the state court rules.

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